Tobacco use is a major cause of preventable death and disease in India. Unfortunately, very few people in India quit tobacco use. Lack of awareness of harm, ingrained cultural attitudes, and lack of support for cessation maintains tobacco use in the community. The significant addictive property of nicotine makes quitting difficult and relapse common. Health professionals have received little training, and very few thus carry out proper assessments and interventions among tobacco users. Evidence from the developed countries suggests that brief interventions delivered by diverse health professionals are effective in tobacco cessation. Combining pharmacologic approaches with behavioral counseling produces better results than a single strategy. In India, early experiences with tobacco cessation occurred in the context of primary community education for cancer control. More recently, tobacco cessation clinics have been set up to develop models of intervention, and train health professionals in service delivery. These need to be expanded at the primary, secondary, and tertiary care levels, and cost-effective community tobacco cessation models need to be developed. Tobacco cessation forms one of the critical activities under the National Tobacco Control Program. Tobacco cessation needs to be urgently expanded by training health professionals in providing routine clinical interventions, increasing availability and subsidy on pharmacotherapy, developing wide-reaching strategies, such as quitlines and cost-effective strategies, such as group interventions.

Objective : To estimate the prevalence, the socioeconomic and demographic correlates of chewable smokeless tobacco consumption among males in India. Design : A cross-sectional, nationally representative population-based household survey. Subjects : 74,369 males aged 15-54 years who were sampled in the National Family Health Survey-3 (2005-2006). Data on tobacco consumption were elicited from male members in households selected for the study. Materials and Methods : The prevalence of various smokeless tobacco use currently was used as outcome measures. Simple and two-way cross tabulations and univariate logistic regression analysis were the main analytical methods. Results : Thirty-four percent of the study population (15 years or older) used chewable smokeless tobacco. Smokeless tobacco consumption was significantly higher in poor, less educated, scheduled castes, and scheduled tribe populations. The prevalence of tobacco consumption showed variation with types. The prevalence of chewing also varied widely between different states and had a strong association with an individual's sociocultural characteristics. Conclusion : The findings of the study highlight that an agenda to improve the health outcomes among the poor in India must include effective interventions to control tobacco use. Failure to do so would most probably result in doubling the burden of diseases-both communicable and noncommunicable-among India's teeming poor. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed.

Background : Tobacco use is a major public health problem in India. The Cigarettes and Other Tobacco Products Act (COTPA) was developed to curb this epidemic. Because no study has been conducted on the awareness, attitude and perceived barriers regarding the implementation of COTPA, this study was undertaken. Materials and Methods : A community-based cross-sectional survey was conducted among 300 adults (mean age 41 years, 52% men) selected by cluster sampling method from Guwahati Municipal Corporation. Information on awareness, attitude and their predictors and barriers for implementation was collected using a pretested, structured interview schedule. Multivariate analysis was done using SPSS. Results : Adults older than 50 years were 3 times (odds ratio [OR] 3.02, 95% CI 1.44-6.31) and those with more than 10 years of schooling were 4 times (OR 3.60, 95% CI 1.70-7.70) more likely to have good awareness of COTPA compared with their counter parts. Those belonging to the middle socioeconomic status (SES) were 3 times (OR 3.36, 95% CI 1.13-10.01), those who reported secondhand smoking harmful were 3 times (OR 3.32, 95% CI 1.45-7.62), and those with more than 10 years of schooling were 3 times (OR 2.92, 95% CI 1.01-8.45) more likely to have positive attitude toward COTPA compared with their counterparts. Lack of complete information and awareness of the Act, public opposition, cultural acceptance of tobacco use, lack of political support, and less priority for tobacco control were reported as barriers for COTPA implementation. Conclusion : Efforts should be made to increase the awareness of COTPA focusing on younger population, less educated, and those belonging to the low SES.

Background : Currently, the health scenario is riddled with the burden of noncommunicable diseases. Aim : The aim of this study is to assess the awareness of school children regarding the risk factors of noncommunicable diseases (NCD). Setting and Design : Three hundred and seventy-five school children, studying in classes 6 to 10, formed the study subjects. Materials and Methods : The school selected for the study was a government school, located in a rural area. The socioeconomic status of the children was mainly in the upper lower and lower class. Students from the 6 to 10 grades formed the study subjects and from among them, a random sample of 375 children were selected for the study. A close-ended questionnaire relating to 3 most commonly occurring NCDs, namely, Cancer, Cardiovascular Diseases (CVD), and Diabetes Mellitus (DM) was administered to the students. Statistical Analysis: Frequency and proportions were used to analyze the data. Results : It is found that awareness among the school children regarding lifestyle risk factors of NCDs is not satisfactory. The areas of least knowledge were found to be regarding passive smoking, early age at marriage, and reuse of cooking oil as risk factors for NCD. Conclusion : The study recommends the need for curriculum-based health education regarding the prevention aspects and motivation of the children to incorporate healthy lifestyle practices into their daily lives.

The 2003 India Tobacco Control Act (ITCA) includes provisions designed to reduce tobacco consumption and protect citizens from exposure to secondhand smoke. India ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) on February 27, 2005. The WHO FCTC is the world's first public health treaty that aims to promote and protect public health and reduce the devastating health and economic impact of tobacco. The Global Health Professions Student Survey (GHPSS) was developed to track tobacco use among third-year dental, medical, nursing, and pharmacy students across countries. Data from the dental (2005), medical (2006), nursing(2007), and pharmacy (2008) GHPSS conducted in India showed high prevalence of tobacco use and a general lack of training by health professionals in patient cessation counseling techniques. The Ministry of Health and Family Welfare could use this information to monitor and evaluate the existing tobacco control program effort in India as well as to develop and implement new tobacco control program initiatives.

Context : India is known as the Business Process Outsourcing (BPO) capital of the world. Safeguarding health of millions of youngsters employed in this new growing economy is an occupational health challenge. Aims : This study was initiated in June 2007 in India with the objectives to assess the prevalence of tobacco use and study the factors responsible for initiating and continuing its use. The main aim, however, was to assess the effect of different tobacco cessation intervention strategies, thus identifying effective methods to assist these employees to quit tobacco. Materials and Methods : This is a 4-arm cluster randomized trial of 18 months duration among 646 BPO employees, working in 4 different BPO units. The employees were invited to participate in interviews following which tobacco users of each BPO were offered specific tobacco cessation interventions to assist them to quit tobacco use. Results : The prevalence of tobacco dependence is 41%, mainly cigarette smoking. The tobacco quit rate is similar (nearly 20%) in the 3 intervention arms. Significantly higher reduction in tobacco consumption of 45% is seen in Arm 4 with the use of pharmacotherapy. BPO employees change jobs frequently, hence follow-up remains a major challenge. Conclusion : Inaccessibility of pharmacotherapy in the developing countries should not deter tobacco cessation efforts as good tobacco quit rates can be achieved with health education and behavioral therapy. Tobacco cessation should be an integral activity in all BPOs, so that the employees receive this service continuously and millions of our youths are protected from the hazards of tobacco.

Beginning with the Cigarettes Act, 1975, a number of legislative strategies and programs to curb tobacco use have been implemented in India, with limited success. Currently, the Cigarettes and Other Tobacco Products Act, 2003, is designed to curb the use of tobacco in order to protect and promote public health. This review presents a critical appraisal of the current situation in its historical context.

Aim : A study was carried out to understand the process of interference by the tobacco industry, to measure the compliance of the industry for displaying pictorial warnings on a tobacco product as per the packaging and labeling rules post 31 st May, 2009, and to understand the public opinion on the messages conveyed through such warnings. Materials and Methods : A total of 60 samples of tobacco products were purchased after 31 May, 2009, from the retail vendors of tobacco sellers across the country. Results : The government of India has from time to time, taken measures, including legislations, to control tobacco consumption. The actual implementation of these rules has been postponed repeatedly, apparently because of constant pressure exerted by the tobacco industry. The skull and bone sign hurting religious sentiments as stated by the group of ministers proved to be misleading. Later the Group of Ministers (GOM) proposed three very weak and poorly communicative pictorial health warnings to replace those recommended by the Union Health Ministry based on the inputs of the Department of Audio Visual Publicity (DAVP). The industry tried to use strategic means by displaying a dull, diluted, and watered down pictorial warning. The focus group study conducted showed that a scorpion gets associated with the product in a non-scientific manner. X-ray of the lung was hardly understood by anybody. Conclusion : Overall the tobacco industry has constantly flouted with the law right from the policy level to its implementation by displaying dull, diluted, and poorly informed pictorial warnings.

Background : More than one-third of the tobacco consumed regionally is of smokeless form. Aims : To determine the prevalence and pattern of smokeless tobacco use among school children. Settings and Design : This cross-sectional study was conducted among children in 5 randomly selected high schools in Kannur district, Kerala, India. Materials and Methods : This cross-sectional study was conducted among 1200 children. A self-administered questionnaire was used for data collection. Statistical Analysis : PASW 17 software was used for data analysis. Results : The mean age of the students was 14.4 years with a standard deviation (SD) of 1.2 years, and 8.5% (CI, 7.1-10.2) of the participants were tobacco users. Smokeless tobacco was used by 2% (CI, 1.2-3.4) of the participants. None of the female students used tobacco products. Among the tobacco users, the mean age at the start of any tobacco use was 12.8 years with an SD of 1.1 years. The minimum age was 12 years and the maximum was 14 years. More than 50% smokeless tobacco users started their habit at the age of 12 years; 38.5% of them started at the age of 13 years and remaining at the age of 14 years. The 84.6% smokeless tobacco users were using it 2-3 times a week and 39% of them revealed that the tobacco products were purchased from shops located near the schools. Among the users, one used to keep the quid in the mouth for more than half an hour. Conclusion : The study concludes that there is a need to educate the children regarding the hazards associated with tobacco consumption.

Tobacco is a well-acknowledged social and health evil. The history of tobacco use traces back to the dawn of human civilization and has been deeply entrenched into the human society since time immemorial. The social, economic, and health impact of tobacco has been a subject of intense debate over the recent decades. For India, this problem has been a unique one, with the consumption patterns either largely influenced by the socioeconomic backgrounds or dictated by the cultural diversity. With more than 200 million tobacco consumers in the country at present, it becomes imperative to address this health hazard and stir up strong measures toward damage control. This article addresses the tobacco problem, its evolution, and the factors that have affected the growth of Indian tobacco industry. It also highlights the current legislative measures against tobacco, fiscal gains to the government, and the serious health and economic impact to the consumer, compounded by the increasing cost of private health care in the present era of consumerism.

Background : Tobacco use is a health hazard and its use is attributed to a lack of knowledge regarding the ill effects of tobacco. Aim and Objective : To identify the exposure of different mass media among a representative cohort population in the Indian subcontinent and compare the reach of the different mass media among tobacco users and nonusers using the "reach of HIV information" as a model. Design : Secondary Data Analysis of Indian National Family Health Survey-3. Predictor Variables : Any tobacco use, gender, source of HIV information. Outcome Variables : Use of mass media. Results : Of the study group, 27% of males and 54.4% of females never read newspaper or magazine; 29.3% of males and 52.6% of females never heard radio; 12.4% of males and 25% of females never see television; and 79.3% of males and 93.46% of females did not see a movie at least once a month. The most common source of information of HIV was television among males (71.8%) and females (81%), whereas the least common source was leaders among males (0.8%) and females (0.2%). Discussion : Television is the single largest media used by both genders and was a major source of HIV information dissemination. A well-designed tobacco control program similar to HIV awareness program will help to curb tobacco use. Conclusion : The reach of different media among Indian tobacco users is presented and HIV model of information dissemination may prove to be effective in tobacco control.

Background : The current study entailed a survey of children from the lower socioeconomic strata of rural and urban regions of the states of Maharashtra and Assam who are vulnerable to tobacco usage. More than 1700 children were checked for precancerous lesions and 1004 were surveyed for tobacco habits and awareness. Aims: The objective of the survey was to determine and report on all the variant factors affecting the use of tobacco among the underprivileged children population. The aim of the clinical check-up was to detect precancerous lesions in the tobacco-using children at an early treatable stage. Materials and Methods : Awareness lectures and ENT camps were conducted at 12 organizations/community centers. A cross-section of children were interviewed to understand tobacco use among them. All the children were screened for precancerous lesions. Children with suspicious oral lesions were sent for further evaluation at a nearby diagnostic cancer facility. The survey was conducted by trained social workers. Results : The percentage of tobacco users in urban Mumbai was quite low at 4.8% compared with rural Kasara (36%) and Assam (76%); and 74.6% of the children were aware that tobacco use was dangerous and harmful to health. The average age of initiation was 9 years. Out of the 1004 children surveyed, 253 were tobacco users and 79% were males. Of the 1700 children screened, 23.5% presented with precancerous oral lesions. Conclusion : This study addresses the tobacco habits of a typical sample of marginalized children in India and the need for effective interventions aiming at reducing the burden of tobacco-related cancers by controlling at the point of initiation.

Background : Second-hand smoke is a grave hazard to both smokers and nonsmokers. Aims : To assess the attitude of general public toward establishing smoke zones in public places. Settings and Design : A cross-sectional survey was conducted among people residing in one randomly selected municipality of Kannur district in Kerala state, India. Materials and Methods : A total of 1000 individuals participated in the study. An open-ended, semi-structured, interviewer-administered questionnaire, which was pilot tested was used to collect information from people willing to participate in the study. Statistical Analysis : Descriptive statistics was used. Statistical analysis was performed by using PASW 17. Results : 73.1% of the total participants indicated a positive attitude toward establishing smoke zones in public places. All female participants and 69.7% of male participants had positive attitude toward establishing smoke zones in public places. Most nonsmokers (83.2%) showed a positive attitude toward establishing smoke zones. A statistically significant (P < 0.001) association was observed between smoking habit and attitude toward establishing smoke zones in public places. Among males, a statistically significant (P < 0.001) association was observed between age and attitude toward the need for smoke zones. As age increased, the attitude toward establishing tobacco smoke zone in public places was found to become more positive. Conclusion : Most of the participants had positive attitude to prohibition of smoking in public places in order to safe guard the public from the harmful effects of Environmental Tobacco Smoke.

Background : In India, NGOs play a key role in creating a supportive environment for the control of tobacco consumption. Aims : This study was conducted to assess the scope and the extent to which community-based women organizations are involved in tobacco control activities. To assess the scope and extent of participation in tobacco control activities according to the sociodemographic characteristics and also the extent to which they have participated in tobacco control activities. Settings and Design : The participants were Kudumbasree volunteers from the rural areas of Kannur district of Kerala state, India. This population-based study adopted a cross-sectional design. Materials and Methods : A self-administered, structured, close-ended, pre-tested questionnaire was prepared and used to collect data from 1000 female volunteers who participated in the study. Statistical Analysis : Chi-square test was used to compare nonparametric variables, such as education, marital status, and age with attitude toward tobacco control activities. Results : Age of the participants ranged from 17 to 53 years. The association between education level and positive attitude to participate in tobacco control activities was found to be statistically significant (P < 0.001). A statistically significant association between participation in tobacco control activities and marital status (P < 0.001) was observed. With regard to education and readiness/willingness to participate in tobacco control activities, in all the education groups more than 90% were willing to participate in tobacco control activities. Among the ever married participants, 98% were willing to participate in antitobacco activities. Old age, husband working in a beedi factory, or not being able to make frequent visits were the reasons reported for their unwillingness of the remaining people. Conclusion : Based on the findings, a set of Kudumbasree volunteers were trained in tobacco and health to work in the community.

Background : In order to control the tobacco scourge, an array of measures is required. Aims : To determine the attitude of unmarried females toward tobacco smokers and ascertain their attitude toward marrying a smoker. Settings and Design : Female students from randomly selected colleges in Kannur district, Kerala state, India, were the participants for this cross-sectional study. Materials and Methods : Sample consisted of 1800 unmarried female students from two colleges. A self-administered, structured, close-ended pilot-tested questionnaire was used for data collection. Data were collected after obtaining verbal consent from them. Statistical Analysis : Data collected were entered into an excel spread sheet and analyzed using PASW 17 software. Results : The participants' age ranged between 17 and 25 years. About 59.6% revealed that their parents (father) used tobacco products. Of those with no family history of tobacco use, 96.5% had negative attitude toward tobacco smokers, whereas of the participants with family history of tobacco use among parents, 89% were with a negative attitude toward tobacco use or their parent's habit. This association was found to be statistically significant (P < 0.001); 79% expressed negative attitude toward their male co-students who use tobacco products. Of the total, 99.3% expressed their unwillingness to marry a person with the habit of tobacco use, whereas 0.7% were willing to marry a person with tobacco habit with the belief that they could bring about a change in their male partner's tobacco habit. Conclusion : More comprehensive tobacco control activities can be undertaken in the community and colleges by incorporating female students as facilitators.

Background: Tobacco use is a serious public health challenge in several regions of the world, including India. Increasingly, steps are being taken at policy level to curb the problem. Aim: This study was done to find out the determinants of tobacco use so that effective intervention programs can be designed and implemented for the prevention and cessation of this growing pandemic. Methods: A community-based cross-sectional study was done adapting Global Youth Tobacco Survey questionnaire prepared by the Centre for Disease Control, Atlanta, among youth (15-24 years). Patterns of smoking and their determinants were calculated using univariate and multivariate analyses. Results: Prevalence of current smoking among youth was 20.4% (95% confidence interval: 16.9-23.9%). Male sex, smoking peers, cigarette advertisements, and feeling comfortable in social gatherings were significant determinants for smoking after adjusting for all explanatory variables. Conclusion: Strict enforcement of regulations pertaining to cigarette advertisements in any form, enabling environment and community interventions focusing on parents and peers are required for effective control of tobacco problem among youth in India.

Background : The Indian government enacted 'The cigarettes and other tobacco products act, 2003' (COTPA), which prohibits smoking in public places. Aim : To validate the efficacy of the Act of 2003, enacted by the Government of India, to prevent secondhand smoking in public places. Settings and Design : The study is based on a non-random sample survey of 2,600 bus passengers carried out in the premises of three mega public road transport organizations in Karnataka state, India, in June 2007. Methods and Material : The information was gathered through administration of structured schedules. A sample of 1,000 each for the terminus of Bangalore Metropolitan Transport Corporation (BMTC) and Karnataka State Road Transport Corporation (KSRTC) in Bangalore and, 600 for North West Karnataka Road Transport Corporation (NWKRTC) in Hubli-Dharwad city was distributed proportionately according to the number of platforms in each terminus. Statistical Analysis Used : Simple Averages. Results : There is some reduction in smoking in general as perceived by 69% of the passengers as compared to the scenario a year before the enactment of COTPA. The observed smoking is lower in the bus premises of BMTC where there is strict regulation, and higher in the bus premises of NWKRTC, which has not taken any regulatory measures. Conclusions : Knowing smoking is banned in public places can itself create awareness depending on the coverage extended by media and implementing an agency to reach the public. The implementation of an act depends on the willingness of stakeholders to act upon it. The implementation of COTPA as done by BMTC could well become a role model for replication elsewhere, if BMTC can strive harder to accomplish a 100% smoke-free zone.

'The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation Trade and Commerce, Production, Supply and Distribution) Act, 2003,' known as COTPA in short, was enacted by the Government of India to control the tobacco menace. One of the successful strategies adopted by the government of Tamilnadu for implementing this Tobacco Control Act was the concept of 'Smoke-free educational institutions'. The process for having smoke-free educational institutions was started by the NGOs motivating the school authorities, to ensure that the set of guidelines, which were devised based the COPTA Act, was followed. The institution was later certified as a smoke-free institution, after verification by the government. The role of the stakeholders and the challenges we faced are discussed in this article.